BCG-Related Renal Granulomas Managed Conservatively

Authors

  • Talal Al-Qaoud McGill University
  • Fadi Brimo
  • Armen G. Aprikian
  • Sero Andonian

DOI:

https://doi.org/10.5489/cuaj.2664

Keywords:

BCG vaccine, intravesical administration, kidney neoplasms, granuloma

Abstract

Introduction: The aim of this case series is to present two cases of renal granulomas discovered incidentally post-intravesical Bacillus Calmette-Guerin (BCG) installations and were managed conservatively.

Case reports: The first case is a 68-year-old man with bladder and right ureteral orifice carcinoma in situ. After transurethral resection of the right ureteral orifice and bladder tumours, he received 6 + 3 weekly intravesical installations of BCG and then 6 + 3 weekly intravesical installations of BCG with interferon alpha (IFN) in the presence of an indwelling ureteral stent since he had refused cystoprostatectomy. At the 18-month follow-up, his computed tomography scan showed two right renal masses. Biopsy demonstrated non-necrotizing granulomatosis. Serial follow-up with imaging studies showed complete resolution of these masses without antituberculous medications. The second case is a 74-year old man with left renal high-grade papillary urothelial carcinoma. After ureteral meatotomy and insertion of indwelling ureteral stents, he received 6 weekly intravesical installations of BCG followed by 3 weekly installations of BCG and IFN prior to the definitive management with laparoscopic left nephroureterectomy. Final pathology showed pT1 urothelial carcinoma and an incidental finding of BCG-related renal granulamotosis. The patient has been asymptomatic and did not require anti-tuberculous medications.

Conclusions: While these two cases demonstrate the ability of intravesical BCG to reach the renal pelvis, patients with a history of intravesical BCG with incidental renal masses may benefit from renal biopsy. These renal granulomas may resolve without antituberculous medications.

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Author Biography

Talal Al-Qaoud, McGill University

Urology resident

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Published

2015-04-13

How to Cite

Al-Qaoud, T., Brimo, F., Aprikian, A. G., & Andonian, S. (2015). BCG-Related Renal Granulomas Managed Conservatively. Canadian Urological Association Journal, 9(3-4), E200–3. https://doi.org/10.5489/cuaj.2664

Issue

Vol. 9 No. 3-4 (2015): CUAJ April

Section

Case Series

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